Flaws Found In Medicaid Fraud-fighting

Recovered Money Is Less Than Predicted

September 24, 2005|By Mark Hollis Tallahassee Bureau

TALLAHASSEE — Since taking over as Florida's attorney general in 2003, Republican Charlie Crist has said investigating fraud in Florida's massive $15 billion annual Medicaid budget is among his office's top priorities.

"It's a focus now," Crist told reporters two years ago. "We want to do as much as we can for the people."

But a new state audit finds numerous shortcomings in the fraud-fighting programs of the Medicaid Fraud Control Unit in Crist's office.

The findings arise despite gains made at recovering monies from patients and corporations that have attempted to milk the state's health-care system for the uninsured.

A report this week from the state's auditor general, William Monroe, finds that auditors in Crist's office are not as well-trained as their counterparts in other states. The report also concludes that investigators are recovering less money than Crist predicted and their systems for keeping track of cases isn't operating as it should.

Monroe's report, a follow-up to a critical audit two years ago, says millions of potentially recoverable state tax dollars are still not being collected. The auditors said the unit's "corrective actions [since a 2003 audit] have been insufficient" at fixing problems dealing with computers, processes for distributing recovered monies, staffing issues and other matters.

In addition, Crist's investigators are, in some cases, duplicating work being conducted by the state's health regulatory agency that oversees Medicaid, the Agency for Health Care Administration. Among other errors, they said the fraud unit has distributed at least $5.4 million to the agency that should have been deposited in a state general fund that legislators appropriate.

Medicaid pays for health care for the poor and disabled, including room, board and medical bills for many of the state's nursing home patients. Experts estimate fraud eats up about $1.5 billion a year, or 10 percent of the state's Medicaid budget, lost or stolen dollars that could go a long way toward paying for such things as dental or nursing home care for the poor.

In response to the audit, aides to Crist, a 2006 gubernatorial candidate, say they have made major progress preventing fraud and recovering funds. They note that when they took over the office, the program was in such bad shape that the federal government had placed it on "high risk" status.

"Within six months, Attorney General Crist assembled a new management team for the Medicaid Fraud Control Unit" and improvements were made, said Clay Roberts, a deputy attorney general.

The changes, Roberts says, have increased fraud recoveries by 102 percent in one year and 109 percent in a second year.

Mark Hollis can be reached at mhollis@sun-sentinel.com or 850-224-6214.